15 July 2017

Anemia is a common concern among the elderly; after the age of 50 years, anemia prevalence increases rapidly, especially in men. In community studies, the prevalence of anemia in older men has been reported to range from 11% to 28%. The decline of hemoglobin and development of anemia with age is not part of "normal aging"; it is a sign of health deterioration and disease.

Several studies have suggested that anemia is an independent risk factor for mortality. Men with anemia may be at higher mortality risk than women; in a large-scale investigation of 6880 elderly patients seen in the primary care clinics, even mild anemia without severe comorbidities was associated with nearly double the risk for all-cause mortality in men, but not in women. Anemia also has been shown to pose a greater risk in men with myocardial infarction than in women. Therefore, laboratory investigation of anemia in men older than 50 years is warranted. It is alarming that anemia is rarely acknowledged and investigated among patients.

Here we summarize the results of The Anemia Trial of the Testosterone Trials.

Key Points

Testosterone treatment of older men with low testosterone levels and unexplained anemia corrected the anemia more than placebo. This treatment also corrected anemia more than placebo in men who had anemia of known causes, such as iron deficiency.

Testosterone deficiency in older men results in decreased hemoglobin levels, which can cause mild anemia.

Correcting testosterone deficiency increases hemoglobin levels and tends to correct the anemia, even in the presence of a coexisting cause of anemia (such as iron and/or vitamin B12 deficiencies, chronic inflammation)

15 June 2017

In discussions about side effects of testosterone treatment, prostate cancer and heart disease get most attention. However, as we have described in several study reports published here in the “Research News” section, the widespread fear of prostate cancer and heart disease is unfounded and not supported by medical research.

The expected potential side effect of testosterone treatment - which in fact is a therapeutic effect in men with anemia - is an increased level of red blood cells, known as erythrocytosis or polycythemia. In the context of testosterone treatment, erythrocytosis and polycythemia are used interchangeably to refer to an abnormal increase of hemoglobin or hematocrit, which may increase blood thickness.

Elevated hematocrit is the most common side-effect of testosterone treatment. The consequences of a high hematocrit level is unclear, but it may theoretically be associated with an increased risk of blood clots. Here we summarize the results of an analysis of the effect of testosterone treatment on risk of blood clots, published in the Journal of Investigative Medicine.

Key Points

An expected potential side effect of testosterone treatment is an increased level of red blood cells, which manifests as increased levels of hemoglobin and hematocrit. This “side effect” is actually a desired therapeutic effect in men with anemia.

It has not been directly proven that testosterone-induced elevations in hematocrit may increase risk of blood clots.

Because it is theoretically plausible that high hematocrit levels may increase risk for cardiovascular events – including blood clots - regular monitoring of hematocrit during testosterone therapy is important.

Testosterone treatment may confer several other beneficial effects that counteract possible risks of high levels of hematocrit.